Take Care of Your Feet

Bunions? Hammertoes? Flat arches? How to soothe the aches and choose fit-right shoes

Darlene Cardillo's feet hurt. After decades of jamming them into high heels for work every day, pounding them on a tennis court, and, recently, running hundreds of miles to get ready for her first half-marathon, the pains shooting up the sides of her feet have gotten worse, and she's growing a bunion. "I ice them, put them up, and take ibuprofen," says Cardillo, 58, who lives in Delmar, NY. She even made the ultimate sacrifice: "I'm wearing flats. I had to prioritize — did I want to give up my sport or my beautiful high heels?"

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Cardillo isn't the only one sighing as she packs away her stylish shoes. Overall, 30% of adult women have some kind of foot pain. The odds go up as you get older: Women between 45 and 54 are about twice as likely to suffer as those 35 to 44. Weight gain adds to the problem: As few as 10 extra pounds can trigger foot ills. And if the pain makes it hard to exercise, it can become a cycle — more weight gain and more pain.

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But you don't have to let sore feet keep you out of the gym or away from your favorite fashions. By understanding what causes the problems, you may be able to head them off. Or, if not, simple remedies will often cure them.

If You've Had Kids, Or a Few Too Many Birthdays

The Risk: Flat feet

Each pregnancy can cause changes in your feet, says Melissa Skratsky, D.P.M., a podiatrist in North Chicago, IL. Weight gain often flattens the arch a bit, making the foot both longer and wider. "You may have to go up a half or even a whole shoe size," she notes. Then, as the years roll by, the soft tissue — the tendons, ligaments, and fascia that support the arch — can lose its resiliency, and that can cause arch fatigue and collapse.

Not sure if this is you? Wet one of your feet and stand on a dry surface, suggests Naomi Shields, M.D., a foot and ankle orthopedic surgeon in Wichita, KS. A normal foot makes a print with a band about half its width connecting the ball of the foot to the heel. Someone with high arches will have a narrow band. However, if your feet are flat, you'll see almost your entire footprint.

Often, a low arch or flat foot is not a concern. "But flat feet may overload the tendons and ligaments and cause foot pain or even knee or low-back troubles," says Dr. Shields. You can have pain along the inside or outside of the ankle and foot, and you may develop calluses in the mid-arch.

Rx: Your first move for flat feet that hurt: Choose more supportive shoes (those with a stiffer shank that don't bend in the middle). You could also try inserts or orthotics. "When we get patients in the right orthotic, they'll say, 'My feet don't hurt anymore, and my knees don't hurt. Even my back feels better!' " Dr. Shields reports.

Still, she also warns that orthotics are overprescribed and may not be useful for all diagnoses. (Note, too, that many podiatrists sell orthotics and may have a vested interest in getting you to try them.)

If you do want to try inserts, start with a drugstore brand, and ease into them, suggests podiatrist Louis C. Galli, D.P.M, a clinical instructor in the department of orthopedics at the Mount Sinai Medical Center in New York City. Wear them an hour or two the first day, then for two to four hours on the second. By the fourth day, you should be able to wear them all day — and to tell if they make a difference. If not, your doctor may suggest custom-made orthotics. Be forewarned: These can cost from $200 to $800, and while many people get relief, "there's no guarantee they'll work for you," says Dr. Shields. Indeed, new research from the University of Calgary found that there's still no proven way to make reliable, consistent predictions about which type of insert helps which type of pain.

If You Suffer for Fashion

The Risk: Bunions, hammertoes, neuromas, heel pain, bunionettes

Some 87% of women have worn shoes that hurt their feet, reports the American Podiatric Medical Association, and 29% do so at least once a week. "You can get away with that when you're younger," says Andrew Shapiro, D.P.M., a podiatrist based in Valley Stream, NY, "but as you age, joints get stiffer, and the fat pads that cushion the bottoms of the feet thin out."

Bunions — enlargement of the bone or tissue around the joint at the base of the big toe — affect more than half (55%) of women. They often come from years of wearing ill-fitting shoes, can be painful and unattractive, and — a new study of 2,800 women in England found — may even affect your mood and interest in socializing.

Narrow or pointy shoes, which smush all the toes together, are usually linked to hammertoes — the joint of the toe becomes stiff, with a clawlike appearance. Initially, affected toes are still flexible when you take your shoes off, but left untreated, they become more rigid. High heels can also cause neuromas, painful thickening of nerve tissue in the forefoot (often between the third and fourth toe). Tight shoes can lead to tailor's bunions, sometimes called bunionettes, which form on the outside of the foot, at the base of the little toe.

Rx: Treat shoe-related pain with anti-inflammatory drugs, and by icing the problem area. Keep the ice pack on for 15 to 20 minutes, then take a break for 45 minutes, advises Jeffrey A. Ross, D.P.M., associate clinical professor of podiatry at Baylor College of Medicine in Houston. If the pain persists for more than a few days, see your doctor, who may refer you to a podiatrist or an orthopedist specializing in foot and ankle problems.

Also part of your treatment: a trip to the shoe store. Switching to roomy styles with bigger toe boxes can bring quick relief. And if a hammertoe has created corns or calluses, toe spacers or toe sleeves may help. "They prevent rubbing between the skin and the shoe, which in turn reduces callus and blister formation," says Skratsky. "Just be aware that they take up space inside your shoe, and may restrict the styles you can wear."

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Surgery for these problems is no walk in the park. Over 96,000 hammertoe corrections are performed each year, says the National Survey of Ambulatory Surgery, but one report found that some 17% of those who had the operation were unhappy with the results. Their complaints included toes that were too short, too long, too fat, or even too floppy. And of the 230,000 or so patients who choose bunionectomies, anywhere from 10% to 30% have significant complications. These include infection, nerve damage, ongoing pain, and, most discouragingly, recurrence — the bunion comes back.

So tiptoe, don't dash, to surgery. "Even if your feet hurt and look bad, I tell people to leave them alone — until they actually interfere with your ability to function, like going to work or exercising," says Galli.

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If You Work Out Hard

Overuse injuries sneak up on feet, says Ross, who specializes in treating creaky baby boomers. Plantar fasciitis — irritation of the thick tissue on the bottom of the foot, and the usual source of heel pain — can be caused by any repetitive activity, from slow walking to running. But a new workout, whether it's salsa dancing or a weekend hike, can also trigger it. The achiness can run up and down the sole of the foot, and it's often characterized by intense tightness in the heel first thing in the morning. Achilles tendonitis, which nags at the back of the leg near the heel, afflicts runners and also becomes more common as tendons lose elasticity with age.

You may not think of shin splints and achy knees as having anything to do with feet, but they can be caused by gait problems, such as overpronation (your feet roll inward), says Ross. You can tell if you overpronate by placing your gym shoes on a level surface: If they tilt to the inside, it's likely your feet tend to as well.

Rx: While ice helps most pain, the right workouts are even more important, says Galli. Add stretching to your daily routine (see "The Stretch Solution," next page), and look for ways to mix up your workouts: "If you usually do 30 minutes on the treadmill, switch it up and do 10 on the bike and 10 on the elliptical," Galli suggests.

Finally, if your dogs are still barking after a few days of stretching, ice, and smarter shoes, limp to your doctor (though you need to go right away if you have redness, swelling, or sharp pain). Taking pain relievers for too long can mask other disorders and lead to more difficulties. By treating problems early, you may be able to stop them from becoming chronic and — how's this for motivation? — get back into your favorite shoes.

The Perfect Pair

Most women's feet get bigger through the years, but no one likes to admit it. Next trip to the shoe store, get measured. And while trying shoes on, check for:

Enough space — there should be 3/8 inch to 1/2 inch between the tip of your longest toe and the end of the shoe

Square or rounded toe boxes (or open toes); if you have bunions, make sure the toe box is roomy enough

Sufficient width, gauged by the broadest part of your foot

Minimal slippage at the heel

Wiggle room: When you stand, you should be able to extend all your toes inside the shoe

Instant comfort: Don't count on shoes' stretching; they might, but they'll be squeezing and irritating your feet in the meantime

The Stretch Solution

Regular stretches — to make muscles, joints, and tendons less stiff — may be the only medicine sore feet need. Gregory Florez, spokesperson for the American Council on Exercise, suggests doing these moves daily for 10 minutes; if that's too painful, do less and work up to 10.

Lie on a mat or rug on your back with one leg bent, foot on the mat, and the other leg extending toward the ceiling. Loop a stretchy band or towel over the ball of the extended foot, gently pulling the leg forward. Hold 30 seconds, then switch sides. Start with two reps on each side.

Sitting in a chair, slip off shoes and scrunch toes so your arches rise; release. Next, with feet flat on the floor, flex toes as high as you can; lower. Then, starting with feet flat on the floor, lift entire foot toward shin, leaving heel on the floor. Do two reps of each, but stop if you have pain.

To soothe, or even prevent, soreness, sit in a chair and place any hard, round object under your foot; then roll it back and forth along the arch for two minutes. You can use wooden foot rollers, a rolling pin, or a can. To ice while you roll, fill a 16-ounce bottle with water and freeze.